Thoracic osteochondrosis is a chronic pathology in which the bone vertebrae and the intervertebral discs located between them undergo degenerative changes. Destructive lesions in this zone are quite rare due to low mobility and good protection by the rib frame. Osteochondrosis of the thoracic spine develops unnoticed, progresses slowly but persistently, and is also distinguished by a number of specific symptoms, masquerading as diseases of the internal organs. In this regard, it is very important to seek medical help at the first, still mild, signs of back problems. Timely treatment helps prevent severe complications.
Causes and provoking factors
Degenerative-dystrophic processes in the thoracic segments of the spine occur against the background of endogenous disruptions and under negative external influences. Their development is most often provoked by the following factors:
- hereditary predisposition, the presence of a certain set of defective genes;
- excessive physical exertion, especially lifting and carrying various heavy objects;
- a sedentary lifestyle, causing congestion in the area of the vertebral bodies and intervertebral discs;
- congenital or acquired structural anomalies, for example, accessory vertebrae, lordosis, kyphosis;
- back and/or chest injuries - fractures, prolonged compression;
- flat feet, club feet;
- impaired blood circulation in any, not just the thoracic spinal area;
- frequent hypothermia;
- overweight;
- endocrine pathologies, metabolic disorders, such as diabetes, gout, hypothyroidism, hyperthyroidism;
- systemic diseases - rheumatoid arthritis, systemic lupus erythematosus, scleroderma;
- ankylosing spondylitis.
The strength and mobility of the spine as a whole directly depends on the condition of each department. The disease can be a consequence of untreated, severe lumbar or cervical osteochondrosis.
Smoking, alcohol addiction, and intoxication, including occupational hazards, predispose to the destruction of intervertebral joints with discs consisting mostly of cartilage. Thoracic osteochondrosis is diagnosed more often in the elderly than in young and middle-aged people. This is due to the natural aging of the body, a slowdown in recovery processes, and the presence of one or more somatic pathologies.
Symptoms and signs of the disease
The leading symptom of the degenerative process is pain. Unlike cervical and lumbar osteochondrosis, it is extremely rarely acute, burning, piercing. Patients usually describe the discomfort as dull, aching, or pressing. The pain syndrome may intensify when bending/turning the body, awkward sudden movements, during a coughing attack, or during temperature changes. Its irradiation is noted—spread beyond the affected area. Osteochondrosis of the thoracic spine also manifests itself as follows:
- stiffness, feeling of constraint;
- specific clicks, crunching when changing body position;
- loss of sensitivity, paresis in the form of a sensation of "crawling goosebumps", burning, numbness;
- muscle spasms, further limiting range of motion;
- adoption of a forced position in which discomfort does not arise or is weakly expressed;
- pathological changes in posture, in later stages - gait;
- a slight decrease in growth as a result of the destruction of intervertebral joints and the convergence of the vertebral bodies.
Due to the constant tension of the back muscles, the muscles of the neck and lower back also spasm, which is expressed in the pain of these parts.
The clinical picture of thoracic osteochondrosis is a combination of pain syndromes. The fact is that the affected segments are located in a common innervation zone with many internal organs. If a displaced disc has pinched a nerve root located near the spine, then pain can be felt in them, simulating common pathologies:
- severe cardiac pain resembles angina pectoris and even myocardial infarction;
- pain in the mammary glands becomes the reason for urgent differential diagnosis to exclude tumor processes;
- constant or periodic pain in the right hypochondrium, in the stomach or intestines, resemble those characteristic of gastritis, cholecystitis, and ulcerative lesions.
When osteochondrosis worsens, the lower back or abdomen may hurt. Patients mistake discomfort for signs of renal pathology or gynecological disease. They turn to specialized specialists, who then refer patients to a neurologist or vertebrologist after examination.
Classification, main types
The common classification of osteochondrosis of the thoracic spine is based on the nature of the pain syndrome. There are two types of it:
- dorsago - a sharp acute pain in the sternum, which occurs mainly during prolonged stay in one position of the body, often complicated by a feeling of lack of air when inhaling;
- dorsalgia in the form of mild painful sensations in the back, periodically appearing and subsiding after rest.
This division of pathology into groups allows the doctor to quickly decide on the choice of analgesic.
Stage-by-stage development of thoracic osteochondrosis
In its development, osteochondrosis of the thoracic spine goes through four stages. Each has its own symptoms and radiographic markers. The more pronounced the deformation of the discs and vertebrae, the more intense the pain, stiffness of movement, and paresthesia. The stage of the disease determines the therapeutic tactics.
Stage I
There are no changes on the x-ray yet. However, the intervertebral disc no longer retains moisture well, without which its timely restoration is impossible. It begins to gradually thin out, lose strength and elasticity. Only in some cases does mild discomfort occur in the thoracic region. A person perceives it as muscle fatigue and does not consult a doctor. Therefore, the disease at this stage is usually an incidental diagnostic finding during examination for another reason.
Stage II
The structure of the fibrous ring becomes loose and fibrous. An enlargement of one crack in the disc occurs with protrusion of the nucleus pulposus in this direction. The distance between adjacent vertebrae decreases, as the height of the disc decreases, which is clearly visualized on radiographic images. To compensate for the distribution of loads, muscle tissue is constantly tense. Stiffness increases, the severity of pain is still moderate.
Stage III
The fibrous ring ruptures with the nucleus pulposus being squeezed beyond its boundaries. A disc herniation occurs, which causes severe symptoms and severe complications. There is significant deformation of the vertebral bodies and the formation of single osteophytes (compensatory bone growths). The pain syndrome becomes constant, movements in the back are significantly limited.
IV stage
At this stage, diagnosing thoracic osteochondrosis is not difficult. Connective tissues have grown and multiple osteophytes have formed. Adjacent vertebrae in the segment are blocked, completely or partially immobilized. Nerve roots are often pinched by inflammatory swelling, bone growths, and spasmed muscles. This manifests itself as a burning, shooting pain. The patient copes poorly with household duties and has difficulty moving.
Complications
The development of discogenic myelopathy, a dystrophic disease of the spinal cord resulting primarily from compression by a herniated disc, is dangerous. It is worth noting that with osteochondrosis of the thoracic spine, such a complication is rare. Nevertheless, in clinical practice there have been cases of localization of discogenic myelopathy in one of the lower segments. Due to a gradually increasing neurological deficit, muscle strength decreases and tendon reflexes change. Ischemic areas form and nerve cells die (spinal cord infarction). This is characterized by movement disorders, loss of sensitivity, and trophic disorders.
Diagnostic measures
At the first consultation, the doctor listens to the patient’s complaints, examines him, assesses the level of sensitivity, checks tendon reflexes, studies medical history, and a history of spinal injuries. His diagnosis is confirmed by laboratory and instrumental studies:
- radiography in two projections, according to indications - a targeted image of a certain segment;
- magnetic resonance imaging;
- evoked potentials;
- electroneurography;
- electromyography;
- general clinical blood and urine tests.
To find out the cause of specific symptoms and to exclude somatic diseases with similar clinical manifestations, electrocardiography, ultrasound scanning of cardiac structures, and electroencephalography may be prescribed.
Treatment methods for thoracic osteochondrosis
The therapy is comprehensive, aimed at eliminating symptoms and preventing the spread of the pathological process to other spinal segments. In the acute stage, burning unbearable pain is eliminated by injecting medications, including directly into the affected area. The use of glucocorticosteroids in combination with anesthetics (drug blockades) is usually practiced. In other cases, drug therapy consists of taking tablets, capsules, rubbing in ointments and balms. The use of drugs from the following groups has proven itself to be effective:
- muscle relaxants to relieve muscle spasms;
- nonsteroidal anti-inflammatory drugs with pronounced analgesic activity;
- antispasmodics for pinched nerves;
- means to improve blood circulation;
- preparations with vitamin B6, which improve the transmission of nerve impulses and activate regeneration.
If a radicular syndrome has formed and other complications have arisen, then the person constantly lives in fear of experiencing excruciating pain again, and this can cause mental disorders. Prescribing sedatives and antidepressants can prevent such developments. In addition to medications, the following methods are used in the treatment of osteochondrosis of the thoracic spine:
- therapeutic massage, including vacuum and acupuncture;
- physiotherapeutic procedures - electrophoresis/ultraphonophoresis, magnetic therapy, pulsed currents, UHF therapy, applications with ozokerite or paraffin, acupuncture, hirudotherapy;
- physical therapy and gymnastics;
- spinal traction.
In cases of significant damage to vertebral discs and myelopathy, surgical treatment is always prescribed immediately. The hernial protrusion is removed, microdiscectomy, puncture valorization or laser reconstruction of the disc is performed, an implant is installed or the spinal segment is stabilized.
Prevention of thoracic osteochondrosis
The main goal of primary prevention of thoracic osteochondrosis is to eliminate factors that can trigger thinning and cracking of the intervertebral disc. What doctors recommend:
- avoid excessive stress on the back;
- promptly treat all diseases - infectious, endocrine, inflammatory;
- immediately seek medical help for back injuries, even those that seem minor at first glance;
- give up alcohol and smoking or at least limit them;
- replenish your diet with fatty fish, fresh vegetables, fruits, and dairy products;
- avoid hypothermia;
- Do physical therapy for at least 15 minutes every day.
Such preventive measures are effective for already diagnosed diseases of the thoracic, cervical or lumbar spine. With their help, it will be possible to prevent exacerbations and progression of the degenerative-dystrophic process.
If you have signs of osteochondrosis of the thoracic spine, and you want to get rid of it, contact the clinic for full, competent treatment.
Question answer
What is the difference between intercostal neuralgia and thoracic osteochondrosis?
In fact, intercostal neuralgia is a lesion of the intercostal nerves, which can complicate the course of osteochondrosis. There are two main differences between these pathological processes. Neuralgia is characterized by paroxysmal shooting or burning pain, which intensifies even with inhalation. Thoracic osteochondrosis without infringement of sensitive nerve endings is manifested by dull, as if distant pain.
And the second difference is the forecast. After eliminating the cause of intercostal neuralgia, it disappears without a trace. Osteochondrosis responds well to treatment only in the initial stages of development.